| 聂清芳,章新元,卢道珍,等.不同镇静评分对急性肾损伤机械通气病人 ICU住院时间及机械通气时间的影响:基于 MIMIC-Ⅳ数据库的回顾性研究[J].安徽医药,2026,30(1):128-135. |
| 不同镇静评分对急性肾损伤机械通气病人 ICU住院时间及机械通气时间的影响:基于 MIMIC-Ⅳ数据库的回顾性研究 |
| Impact of different sedation scores on time of ICU stay and mechanical ventilation in patients with acute kidney injury: a retrospective study based on the MIMIC-Ⅳ database |
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| DOI：10.3969/j.issn.1009-6469.2026.01.026 |
| 中文关键词: 急性肾损伤 镇静评分系统 机械通气时间 重症监护室( ICU)住院时间 镇静评分( RASS) 镇静 -躁动评分(SAS) |
| 英文关键词: Acute kidney injury Sedation scoring system Mechanical ventilation duration Intensive care unit (ICU) length of stay Richmond agitation-sedation scale (RASS) Sedation-agitation scale (SAS) |
| 基金项目:江苏省中医药管理局科技发展计划项目( MS2021008)；江苏省中医药管理局中医重点专科项目(苏中医医 |
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| 中文摘要: |
| 目的评估不同镇静评分［Richmond躁动 -镇静评分( RASS)与镇静 -躁动评分( SAS)］对接受机械通气的急性肾损伤(AKI)病人重症监护室( ICU)住院时间和机械通气时间的影响。方法该研究为回顾性队列研究，数据来源于 MIMIC-Ⅳ数据(version 2.2)研究时间范围为 2008—2019年。共纳入 3480例接受机械通气的 AKI病人，根据镇静评分系统分为 RASS组与 SA库S组。通过倾向，得分匹配( PSM)校正基线差异，采用协方差分析( ANCOVA)及多元线性回归评估两组间 ICU住院时间与机械通气时间的差异，并按镇静深度进行亚组分析。结果采用 1∶4最近邻匹配(卡钳值为 0.5，有放回) PSM后纳入 2 088例病人，其中 RASS组病人 1 670例， SAS组病人 418例。 Mann-Whitney U检验显示， RASS组 ICU住院时间为( 145.0±83.2)h，SAS组为( 166.5±87.1)h，差异有统计学意义( P=0.005)； RASS组机械通气时间为( 44.0±35.6)h，SAS组为( 49.8±39.4)h，差异有统计学意义( P=0.009)。为满足参数模型分析的前提假设，采用对数转换处理。对数转换后 ANCOVA分析显示两组间存在 ICU住院时间差异有统计学意义［差值( Difference)＝.0.13，95%CI:(.0.20，.0.06)，P<0.001］；机械通气时间差异有统计学意义［Differ-ence=.0.20，95%CI:(.0.31，.0.09)，P<0.001］。亚组分析显示，在浅镇静策略的病人中， RASS组的 ICU住院时间和机械通气时间显著短于 SAS组(均 P<0.05)而在深镇静策略中，两组间差异无统计学意义。交互作用分析未发现 GCS评分或神经系统疾病对镇静评分( RASS比 SAS)影响，ICU住院时间和机械通气时间的调节作用。结论相比 SAS评分系统， RASS评分系统能显著缩短 AKI病人的 ICU住院时间和机械通气时间，在实施浅镇静管理策略时效果更为明显。 |
| 英文摘要: |
| Objective PThis study aimed to evaluate the effects of different sedation scoring systems—Richmond agitation-sedation scale (RASS) and sedation-agitation scale (SAS)—on intensive care unit (ICU) length of stay and mechanical ventilation duration in me-chanically ventilated acute kidney injury (AKI) patients.Methods This retrospective cohort study was based on the MIMIC-Ⅳ data-base (version 2.2), covering the period from 2008 to 2019. A total of 3 480 mechanically ventilated AKI patients were included and di-vided into RASS and SAS groups according to the sedation scoring system used. Propensity score matching (PSM) was applied to bal-ance baseline differences between groups. Analysis of covariance (ANCOVA) and multiple linear regression were performed to assessdifferences in ICU length of stay and mechanical ventilation duration between the two groups, with subgroup analyses conducted ac-cording to sedation depth.Results After 1∶4 nearest-neighbor PSM (caliper=0.5, with replacement), 2 088 patients were included,comprising 1 670 in the RASS group and 418 in the SAS group. The Mann–Whitney U test showed that the ICU length of stay was (145.0±83.2) h in the RASS group and (166.5±87.1) h in the SAS group (P=0.005). The duration of mechanical ventilation was (44.0± 35.6) h and (49.8±39.4) h, respectively (P=0.009). To meet the assumptions of parametric analysis, logarithmic transformation was per-formed. After log transformation, ANCOVA revealed a statistically significant difference in ICU stay between groups [Difference=.0.13,95%CI: (.0.20, .0.06), P<0.001] and in mechanical ventilation duration [Difference=.0.20, 95%CI: (.0.31, .0.09), P<0.001]. Sub-group analysis showed that among patients under a light sedation strategy, the RASS group had significantly shorter ICU stays and ven-tilation durations than the SAS group (P<0.05), whereas no significant differences were observed under deep sedation. Interaction analy-sis found that neither Glasgow coma scale (GCS) score nor neurological disorders significantly moderated the relationship between se-dation score (RASS vs. SAS) and ICU length of stay and mechanical ventilation duration.Conclusion Compared to the SAS scoringsystem, the RASS scoring system significantly reduces ICU length of stay and mechanical ventilation duration in AKI patients, particu-larly when a shallow sedation strategy is implemented. |
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